Achilles tendon stretching device

ABSTRACT

An Achilles tendon stretching device can include manual or automatic mechanisms to allow incremental height changes to an insole placed within a walking boot, orthopedic shoe, or post surgical shoe, in order to allow more even and gradual and/or incremental stretching of the Achilles tendon. The height adjustment mechanisms can include mechanical, pneumatic, and/or hydraulic adjustment mechanisms, as well as manual incremental removal of integrally formed layers of a heel wedge.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. provisional application Ser.No. 61/360,561, filed Jul. 1, 2010, and U.S. provisional applicationSer. No. 61/453,633 filed Mar. 17, 2011, the disclosure of each of whichare incorporated by reference herein in their entirety, inclusive oftheir specification, claims, and drawings.

FIELD OF THE INVENTION

The present invention relates generally to the field of orthopedic orprosthetic devices and more particularly to a device for use in thetreatment, repair, and rehabilitation of the Achilles tendon followingan injury and/or corrective surgery.

BACKGROUND

Achilles tendon rupture is the most common injury involving a tear in atendon. It commonly occurs as a sports injury during explosiveacceleration, for example, while pushing off or jumping up.

Treatment of Achilles tendon rupture is typically divided betweenoperative and non-operative management, each of which involve thegradual stretching of the tendon after the rupture has healed.

Operative management involves a surgical operation where the rupturedtendon is sutured back together at the point of rupture, and the leg isthen placed into a cast. When the leg is placed in the cast, the foot ispointed downward (in an equinus position). As the healing progresses,the equinus position is then gradually decreased (requiring removal ofthe original cast, and recasting with the newly decreased equinusposition).

Non-operative management typically involves wearing a cast or walkingboot, which allows the ends of torn tendon to reattach themselves ontheir own. In the non-operative option, the foot is pointed downwards,with the help of heel wedges or insoles, which are placed in the walkerboot. The height of the heel wedges or insoles is then incrementallydecreased as the process of healing progresses. One disadvantage ofusing the heel wedges is that reducing the height of the wedges/insolecan be too drastic for the injured tendon.

Both the operative and the non-operative methods involve a longrehabilitation process, lasting at least 6 months. Additionally, in eachsituation, removal of the cast or walking boot is necessary in order toadjust the equinus position of the foot, and/or to remove and replaceheel wedges or insoles having a different height.

Non-operative treatment might seem like a more comfortable way to goabout

Achilles repair, but it does take longer and leaves the patient with agreater risk of re-injury. Immobilization using a plaster cast can takeas long as 12 months for the tendon to return to full strength, whereassurgery may only require anywhere for 6 to 9 months. In the past,patients who underwent surgery would wear a cast for approximately 4 to8 weeks after surgery and were only allowed to gently move the ankleonce out of the cast. Recent studies have shown that patients havequicker and more successful recoveries when they are allowed to move andlightly stretch their ankle immediately after surgery. To keep theirankle safe these patients use a removable boot while walking and doingdaily activities.

In either the operative or the non-operative situation, existing methodsfor stretching the Achilles tendon can be time consuming andinconvenient to implement. Additionally, existing methods for stretchingthe Achilles tendon can cause drastic of changes in stretching thelength of the Achilles tendon, such that the risk of re-rupture of thetendon is increased.

SUMMARY

In view of the above discussion, exemplary embodiments of an Achillestendon stretching device are disclosed that provide improved mechanismsto allow more even stretching of the Achilles tendon, to reduce problemsassociated with edema, and to promote faster healing of the injuredtendon in order to allow for faster recovery and shorter rehabilitationtimes.

Exemplary embodiments of an Achilles tendon stretching device caninclude manual or automatic mechanisms to allow incremental heightchanges to an insole placed within a walking boot, orthopedic shoe, orpost surgical shoe, in order to allow more even and gradual stretchingof the Achilles tendon.

Exemplary mechanisms can include manual or automatic screw mechanisms,as well as manual or automatic pneumatic systems. Manual or automatichydraulic systems are also contemplated.

Other exemplary mechanisms can include the use of a heel wedge havinglayers which can be torn or cut off to adjust the height of the heelwedge.

By utilizing the disclosed exemplary embodiments of an Achilles tendonstretching device, the degree of stretching of the tendon can be moreeasily, and more evenly controlled, in order to avoid drastic changes inthe stretched length of the tendon, which may lead to re-rupture of thetendon.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects, and advantages of the presentinvention will become better understood with regard to the followingdescription, appended claims, and accompanying drawings where:

FIG. 1 is a perspective view of a circumferential type walking boot(walker) in which the exemplary embodiments of an Achilles tendonstretching device may be implemented;

FIG. 2 is a side view of another type of walker in which the exemplaryembodiments of an Achilles tendon stretching device may be implemented;

FIG. 3 is a rear perspective view of a first exemplary embodiment of anAchilles tendon stretching device implemented in a circumferential typewalker;

FIG. 4 represents a partial cut-away side view of the exemplaryembodiment of an Achilles tendon stretching device shown in FIG. 3;

FIG. 5 represents a partial cut-away side view of another exemplaryembodiment of an Achilles tendon stretching device;

FIG. 6 represents a partial cut-away side view of another exemplaryembodiment of an Achilles tendon stretching device;

FIG. 7 represents a partial cut-away side view of another exemplaryembodiment of an Achilles tendon stretching device;

FIG. 8 represents a partial cut-away side view of another exemplaryembodiment of an Achilles tendon stretching device;

FIG. 9 represents a perspective view of another exemplary embodiment ofan Achilles tendon stretching device in the form of a heel wedge havinglayers which can be torn or cut off to adjust the height of the heelwedge; and

FIG. 10 is a partial exploded side view of the Achilles tendonstretching device shown in FIG. 9.

It should be noted that the drawing figures are not necessarily drawn toscale, but instead are drawn to provide a better understanding of thecomponents thereof, and are not intended to be limiting in scope, butrather to provide exemplary illustrations. It should further be notedthat the figures illustrate exemplary embodiments of an Achilles tendonstretching device and the components thereof, and in no way limit thestructures or configurations of an Achilles tendon stretching device andcomponents thereof according to the present disclosure.

DETAILED DESCRIPTION A. Environment and Context

Exemplary embodiments of an Achilles tendon stretching device areprovided for use in the treatment, repair, and rehabilitation of theAchilles tendon following an injury and/or corrective surgery. Featuresthat are provided on one side of the device can easily be provided onthe other side of the device. In this manner, it is intended that theexemplary embodiments of the Achilles tendon stretching device describedherein may be used on either right or left lower legs, with anyappropriate reconfiguration of components that is deemed necessary forthe proper fit and function of the device for the purpose of treatment,repair, and rehabilitation of the Achilles tendon of either the left orright lower leg.

In the exemplary embodiments of the Achilles tendon stretching devicedescribed herein, quick release strap mechanisms may be used to provideease of securing and tightening the device to the lower leg. Exemplaryquick release strap mechanisms are described in U.S. Pat. No. 7,198,610,granted April 2007, commonly owned, and herein incorporated in theentirety by reference.

The exemplary embodiments of the disclosure are adapted for treatment,repair, and rehabilitation of the Achilles tendon of human beings, andmay be dimensioned to accommodate different types, shapes and sizes ofhuman joints and appendages.

The exemplary embodiments of an Achilles tendon stretching device can beimplemented in various configurations of walking boots, orthopedicshoes, or post surgical shoes.

For example, exemplary embodiments of an Achilles tendon stretchingdevice can be implemented within a circumferential type walker 100, asshown in FIG. 1. An exemplary circumferential type walker 100 includes aposterior shell 102 and an anterior, dorsal shell or plate 104, suchthat the lower leg is generally fully enclosed and supported by thewalker 100. An outsole 106 is provided along the distal plantar surfaceof the walker 100.

Further, exemplary embodiments of an Achilles tendon stretching devicecan be implemented within a walker 110, as shown in FIG. 2. The walker110 includes a sole portion 114 having supporting struts 112 extendingtherefrom, and an outsole 116. A liner 118 is provided enclosing thelower leg and positioned between and supported by the supporting struts112.

Exemplary materials and configurations for components of the Achillestendon stretching device, such as sole portions and shell portions, aredescribed in detail in U.S. Pat. No. 5,078,128, granted January 1992,U.S. Pat. No. 5,329,705, granted July 1994, U.S. Pat. No. 5,464,385,granted November 1995, and U.S. Pat. No. 7,303,538, granted December2007, all commonly owned and incorporated herein in the entirety byreference. Additional exemplary materials and configurations forcomponents of the Achilles tendon stretching device can be found in U.S.publication no. 2009/0287127, published Nov. 19, 2009, commonly owned,and herein incorporated in the entirety by reference.

For further ease of understanding the exemplary embodiments of anorthopedic device as disclosed herein, a description of a few terms isnecessary. As used herein, the term “dorsal” has its ordinary meaningand refers to the top surfaces of the foot, ankle and foreleg or shin.As used herein, the term “plantar” has its ordinary meaning and refersto a bottom surface, such as the bottom of a foot. As used herein, theterm “proximal” has its ordinary meaning and refers to a location thatis closer to the heart than another location. Likewise, the term“distal” has its ordinary meaning and refers to a location that isfurther from the heart than another location. The term “posterior” alsohas its ordinary meaning and refers to a location that is behind or tothe rear of another location. Lastly, the term “anterior” has itsordinary meaning and refers to a location that is ahead of or to thefront of another location.

The terms “rigid,” “flexible,” and “resilient” may be used herein todistinguish characteristics of portions of certain features of theorthopedic device. The term “rigid” is intended to denote that anelement of the device is generally devoid of flexibility. Within thecontext of support members or shells that are “rigid,” it is intended toindicate that they do not lose their overall shape when force isapplied, and in fact they may break if bent with sufficient force. Onthe other hand, the term “flexible” is intended to denote that featuresare capable of repeated bending such that the features may be bent intoretained shapes or the features do not retain a general shape, butcontinuously deform when force is applied. The term “resilient” is usedto qualify such flexible features as generally returning to an initialgeneral shape without permanent deformation. As for the term“semi-rigid,” this term is used to connote properties of support membersor shells that provide support and are free-standing, however suchsupport members or shells may have some degree of flexibility orresiliency.

B. First Exemplary Embodiment

A first exemplary embodiment of an Achilles tendon stretching device isshown in FIGS. 3 and 4 as implemented in a generally circumferentialwalker 120 of the type shown in FIG. 1.

As shown, the walker 120 includes a posterior shell 122 and an outsole124. An adjustment dial 126 is provided to allow adjustment of theheight of an insole 134 in order to adjust the amount of stretching ofthe Achilles tendon.

In order to aid with determining the amount of stretching of theAchilles tendon, a marker 130 is provided on the adjustment dial 126which points at distinct indicia 128, for example numerical indicators,provided on the posterior shell 122 and/or the outsole 124. It will berecognized that the indicia may be provided on the adjustment dial 126itself, and the marker may be provided on the posterior shell 122 or theoutsole 124.

In order to provide a more even and less drastic stretching, eachnumerical indication of indicia 128 can represent a height change(increase or decrease) of 1 mm of the insole 134, such that eachincremental movement of the adjustment dial 126 from one indicia to thenext represents a change in height of the insole 134 of 1 mm. Of course,the height change represented by the incremental rotation of theadjustment dial 126 may be more or less than 1 mm.

As shown in FIG. 4, the adjustment dial 126 includes an adjustment screw136 that can be connected to a scissor jack mechanism 138 positionedbetween the insole 134 and a plantar sole portion 132.

The adjustment dial 126 can be manually rotated, and may includeappropriate textures or shapes to aid with manual manipulation such asgripping thereof by the person adjusting the mechanism.

In the exemplary configuration, with manual adjustment of the adjustmentdial 126, a practitioner or other authorized person can rotate theadjustment dial 126 one increment, once a week, in order to decrease theheight of the insole 134 by 1 mm once every week in order to increasethe amount of stretch of the Achilles tendon by 1 mm each week duringuse of the device. In this manner, a more even stretch of the Achillestendon can be achieved, in order to avoid drastic changes in thestretched length of the tendon, which may lead to re-rupture of thetendon. With the exemplary configuration of the Achilles tendonstretching device, the walker 120 does not need to be removed from thepatient in order to achieve adjustment thereof

In a variation, an electric motor 133 (shown in outline in FIG. 4) maybe provided, along with an appropriate control mechanism, in order allowfor automatic adjustment of the adjustment dial 126. Such an adjustmentmay be made once a week, as discussed above, or may be accomplished ineven smaller increments throughout a week in order to provide an evenmore gradual change in the amount of stretching of the Achilles tendon.

Appropriate onboard electronics (including, for example, sensors such asaccelerometers, strain gauges, angle sensors, gyroscopes, etc.) andcommunication mechanisms (such as wireless Internet, Wi-Fi, Bluetooth,infrared, etc.) can be provided 135 (exemplarily shown in outline inFIG. 4) in order to sense the amount of activity of the user (andhealing of the Achilles tendon), to automatically adjust the height ofthe insole 134 appropriately, and to provide communicative messages to apractitioner who may then remotely monitor the progress of the healingof the Achilles tendon.

In another variation of the Achilles tendon stretching device, insteadof the adjustment dial 126, a socket head cap screw (or other suitablemachine screw) can be provided as the adjustment screw 136.

C. Second Exemplary Embodiment

In a second exemplary embodiment of an Achilles tendon stretching deviceshown in FIG. 5, a generally circumferential walker 140 has a posteriorshell 142, a planter sole 146, and an outsole 144.

In contrast to the embodiment shown in FIGS. 3 and 4, the adjustmentmechanism is provided through the plantar sole 146 and the distalsurface of the outsole 144. Additionally, instead of an adjustment dial,a socket head cap screw (or other suitable machine screw) is provided asthe adjustment screw 150. The practitioner can utilize an Allen wrenchin order to adjust the height of the insole 148 in order to adjust theamount of stretching of the Achilles tendon.

The far end of the adjustment screw 150 can be connected to the insole148 by way of a universal joint 152, which allows rotation of the end ofthe adjustment screw 150, while providing a vertical translation of theinsole 148.

Instead of the socket head cap screw, a dial with indicia, similarly toadjustment dial 126, may be used.

Rotation of the adjustment screw 150 to decrease the height of theinsole 148 will cause the socket head portion of the adjustment screw150 to become spaced from the plantar sole 146. The depth of the openingin the outsole 144 should be sufficient to accommodate the movement ofthe socket head portion of the adjustment screw 150.

Alternatively, an appropriate mechanical mechanism can be provided tocause the rotation of the adjustment screw 150 to be translated into thevertical height adjustment of the insole 148, without any correspondingvertical movement of the adjustment screw 150, such as for example, ascissor jack mechanism.

Similarly as discussed above, an electric motor and associated controlmechanisms can be provided in order to allow automatic (gradual and/orincremental) adjustment of the adjustment screw 150.

In a variation shown in FIG. 6, the adjustment screw 150 may be replacedby a pneumatic or hydraulic piston and cylinder 154, which may becontrolled in a known manner to achieve vertical height adjustment ofthe insole 148 with respect to the plantar sole 146.

Like the previously discussed embodiment, a practitioner can adjust thisAchilles tendon stretching device once a week, in order to decrease theheight of the insole 148 by 1 mm once every week in order to increasethe amount of stretch of the Achilles tendon by 1 mm each week duringuse of the device. In this manner, a more even stretch of the Achillestendon can be achieved, in order to avoid drastic changes in thestretched length of the tendon, which may lead to re-rupture of thetendon. Similarly, with this exemplary configuration of the Achillestendon stretching device, the walker 140 does not need to be removedfrom the patient in order to achieve adjustment thereof.

D. Third Exemplary Embodiment

A third exemplary embodiment of an Achilles tendon stretching device isshown in FIG. 7. In this embodiment, a walker 160 includes a posteriorshell 162, a plantar sole 166, an outsole 164, and an adjustable heightinsole 168.

A pneumatic bladder 170 constructed of suitable materials capable ofretaining a gas such as air therein, is provided between the plantarsole 166 and the insole 168. A valve mechanism 172 is provided at theposterior of the bladder 170 and protruding through an opening in theposterior shell 162 for access thereto by a practitioner. Any suitablevalve mechanism, such as, for example a Schrader valve or a Prestavalve, can be provided. It will be recognized that the valve mechanism172 can alternatively be positioned to protrude through the plantar sole166 and outsole 164.

Once a week, the patient can visit the practitioner, and thepractitioner can release an appropriate amount of gas from the bladder170, using the valve 172, in order to decrease the height of the insole168 by an appropriate amount, for example, 1 mm.

Like the previously discussed embodiments, the walker 160 need not beremoved from the patient in order to effectuate adjustment of the heightof the insole 168. Similarly, a more even stretch of the Achilles tendoncan be achieved, in order to avoid drastic changes in the stretchedlength of the tendon, which may lead to re-rupture of the tendon.

As a variation, a slow leak valve can be provided to automatically andcontinuously release a predefined amount of gas from the bladder 170 inorder to automatically and gradually reduce the height of the insole168, for example, an amount of 1 mm per week. Such a slow leak valve canbe, for example, a slit valve designed to allow the slit to partiallyopen in response to a continuous predefined pressure applied by theweight of the wearer of the walker 160. Alternatively, the slow leakvalve can be any mechanical valve that can be set to an open or closedconfiguration, and which can be set in a slightly opened position toallow the slow leak. For example, any suitable ball valve, disc valve,butterfly valve, etc., may be utilized as a slow leak valve.

As a further variation, appropriate processor and automatic valve (forexample an electrically operated solenoid valve) mechanisms can beprovided to effectuate gradual and/or incremental release of gas fromthe bladder 170.

In yet another variation, as shown in FIG. 8, a walker 180 includes aposterior shell 182, a plantar sole 186, an outsole 184, an adjustableheight insole 188, and a bladder 192 having a valve 194. This variationof the Achilles tendon stretching device functions in generally the samemanner as the device shown in FIG. 6, with the exception that inaddition to the bladder 192 positioned between the plantar sole 186 andthe insole 188, removable and interchangeable heel wedges 190 havingdifferent heights are provided (one at a time) between the bladder 192and the insole 188 and the plantar sole 186. Alternatively, multipleheel wedges of consistent heights can be provided in place of theinterchangeable heel wedges 190.

With this configuration and an automatically controlled release of gasfrom the bladder 192, the height of the insole 188 would graduallydecrease throughout a week, and when the patient visits thepractitioner, the heel wedge 190 can be replaced with a heel wedge oflower height (or one of the multiple heel wedges can be removed) and thebladder 192 can be reinflated.

While pneumatic bladders and valves are disclosed, it is contemplatedthat hydraulic bladders and valves may also be used.

Again, these configurations provide for a more even stretch of theAchilles tendon can be achieved, in order to avoid drastic changes inthe stretched length of the tendon, which may lead to re-rupture of thetendon.

E. Fourth Exemplary Embodiment

A fourth exemplary embodiment of an Achilles tendon stretching device inthe form of a heel wedge 200 having layers 202, 204, 20, 208 which canbe torn or cut off to adjust the height of the heel wedge is shown inFIGS. 9 and 10.

The heel wedge 200 can be used in any orthopedic device for use with thefoot, for example, walkers, diabetic walkers, post-op shoes, anklebraces, or any type of footwear, such as shoes or boots.

The heel wedge 200 can be made from any suitable material, for exampleethylene-vinyl acetate (EVA) foam. Further, the heel wedge 200 can bemade from compression molded EVA foam. Exemplary EVA foam can have adensity/hardness in the range of 35-60 shore. Another suitable materialmay be an artificial cork, such as an EVA cork mixture that is thermomoldable at approximately 120 to 140 degrees and results in adensity/hardness of 50 shore. Another exemplary material may bepolyurethane.

As shown in FIGS. 9 and 10, the heel wedge 200 has a number of layers,all of which are integrally formed and connected together at an anteriorportion of the heel wedge 200. As shown the heel wedge 200 includesfirst layer 202, second layer 204, third layer 206, and fourth layer208. However, the number of layers shown is merely exemplary, and anysuitable greater or lesser number of layers, for example ten to fifteenlayers, may be used in order to achieve the desired amount andincrements of height adjustment.

In use, the heel wedge 200 can be positioned within the heel portion oforthopedic device with all of the integrally formed layers thereofretained. Thus, the Achilles tendon of a user of the heel wedge 200 willbe shortened to a first length.

In order to incrementally stretch the Achilles tendon of the user of theheel wedge 200, the layers 202, 204, 206, 208 thereof can beincrementally cut or torn from the heel wedge 200 in order to reduce theheight of the heel wedge 200, thus stretching the Achilles tendon of theuser to incrementally greater lengths.

The thickness or height of the layers 202, 204, 206, 208 corresponds tothe desired incremental stretch length of the Achilles tendon, and maybe any desired thickness or height.

In use, to adjust the stretch length of the Achilles tendon at a firsttime, the heel wedge 200 can be removed from the heel portion oforthopedic device. Then, the first layer 202 can be torn or cut awayfrom the heel wedge 200, which can then be replaced in the heel portionof orthopedic device.

Treatment can then occur for the desired length of time to stretch theAchilles tendon at the length that is provided by removing the firstlayer 202 of the heel wedge 200. This process can be repeated asnecessary by removing subsequent layers 204, 206, 208 in succession totreat Achilles tendon injuries and surgical recovery with incrementalstretching of the Achilles tendon.

It is noted that if greater height adjustment is needed during aspecified treatment period, more than one of the adjacent layers 202,204, 206, 208 can be removed simultaneously. For example, after aninitial treatment period using the heel wedge 200 having layers 202,204, 206, 208, the adjacent first and second layers 202, 204 can be tornoff of cut away in order to provide a greater height adjustment toincrease the amount that the Achilles tendon is stretched.

This process can allow the use of a heel wedge 200 having numerouslayers of minimal thickness, for example 1 mm, for numerous treatmenttherapies for Achilles tendon injuries. Such a heel wedge and processcan then be modified for each particular treatment protocol, where, forexample one protocol requires an incremental height adjustment of 1 mmper week, and another treatment protocol requires an incremental heightadjustment of 5 mm per week.

For the treatment protocol requiring an incremental height adjustment of1 mm per week, only a single layer of the heel wedge 200 would beremoved each week. Similarly, for the treatment protocol requiring anincremental height adjustment of 5 mm per week, five of the layers ofthe heel wedge 200 would be removed each week.

Thus, in this manner, only one type of heel wedge 200 need bemanufactured in order to satisfy numerous treatment protocols.

In order to provide additional stability to the Achilles tendon, and toprevent slipping of the user's heel within the orthopedic device and,therefore inadvertent stretching of the Achilles tendon, a heel stop 210can be provided on the proximal surface 212 of the heel wedge 200.

The heel stop 210 can be formed, for example, from a compression moldedEVA foam, or can be an injected molded thermoplastic elastomer (TPE), orany other suitable material.

As seen in FIGS. 9 and 10, the heel stop 210 can have a generallytriangular shape, with a raised ridge provided on a proximal surfacethereof, such that the raised ridge provides a stop against forwardmigration of the user's heel during use. In an alternativeconfiguration, the heel stop 210 can have a generally trapezium ortrapezoidal shape, such that a planar surface is provided at the raisedridge. The planar surface can thus provide an additional frictionalsurface to engage at least a portion of the arch of the user's foot inorder to prevent slippage of the user's heel.

The heel stop 210 can be glued or secured with adhesive directly to theproximal surface 212 of the heel wedge 200. Alternatively, the heel stop210 may be held in place on the proximal surface 212 of the heel wedge200 by the weight of the user and frictional forces.

Thus, it can be seen that the heel wedge 200 having a number of layers,all of which are integrally formed and connected together at an anteriorportion of the heel wedge 200, and which can be selectively removed asdesired to achieve incremental height adjustment and stretching of theAchilles tendon provides a convenient and simple way to effect treatmentand recovery for Achilles tendon injuries and surgeries.

F. Conclusion

It will be recognized that the exemplary embodiments of an Achillestendon stretching device and components thereof can be made from anysuitable materials.

While one week has been described above as a suitable time period formeasuring when adjustment to the Achilles tendon stretching deviceshould be made, it will be recognized that any suitable or desired timeperiod may be utilized.

It will also be recognized that the various locations of each of theadjustment mechanisms of the exemplary Achilles tendon stretchingdevices described herein can be variously located in any convenientlocation, for example, at the posterior of the walker or in the plantarsole region of the walker.

While specific mechanical mechanisms (for example, a scissor jack or asocket head cap screw and universal joint) are described herein foradjusting the height of an insole with respect to the planter sole of awalker, any suitable mechanical, pneumatic, and/or hydraulic mechanismcan be used to adjust the height of the insole. For example, pneumaticor hydraulic cylinders and pistons may be positioned between the insolesand plantar soles and used to raise and lower the adjustable heightinsoles. For example, a pneumatic or hydraulic cylinder and piston canbe oriented to provide vertical translation to raise or lower the insolewith respect to the plantar sole. Such pneumatic or hydraulic cylindersand pistons can be configured to automatically adjust height, eitherincrementally or continuously, as discussed in detail above with respectto alternatively recited configurations. The specific design andimplementation of such pneumatic or hydraulic cylinders and pistons willbe recognized by a person having skill the art.

Of course, it is to be understood that not necessarily all objects oradvantages may be achieved in accordance with any particular embodimentof the invention. Thus, for example, those skilled in the art willrecognize that the invention may be embodied or carried out in a mannerthat achieves or optimizes one advantage or group of advantages astaught herein without necessarily achieving other objects or advantagesas may be taught or suggested herein.

The skilled artisan will recognize the interchangeability of variousdisclosed features from the disclosed embodiments and variations. Inaddition to variations described herein, other known equivalents foreach feature can be mixed and matched by one of ordinary skill in thisart to construct an Achilles tendon stretching device in accordance withprinciples of the present invention.

Although this invention has been disclosed in the context of exemplaryembodiments and examples, it therefore will be understood by thoseskilled in the art that the present invention extends beyond thespecifically disclosed embodiments to other alternative embodimentsand/or uses of the invention and obvious modifications and equivalentsthereof. Thus, it is intended that the scope of the present inventionherein disclosed should not be limited by the particular disclosedembodiments described above.

1. An orthopedic device for use as an Achilles tendon stretching device,comprising: footwear having a height adjustable insole and a plantarsole, wherein a manual or automatic height adjustment mechanism isprovided to gradually and/or incrementally adjust the height of theinsole with respect to the plantar sole.
 2. The orthopedic deviceaccording to claim 1, wherein the height adjustment mechanism comprises:an adjustment screw; and an adjustment dial.
 3. The orthopedic deviceaccording to claim 2, wherein the height adjustment mechanism furthercomprises: a jack mechanism positioned between the insole and theplantar sole, wherein rotation of the adjustment dial causes rotation ofthe adjustment screw to raise or lower the jack mechanism in order toadjust the height of the insole with respect to the plantar sole.
 4. Theorthopedic device according to claim 2, wherein the adjustment dial orthe footwear includes a marker, which points at distinct indiciaprovided on the footwear or the adjustment dial in order to represent anincremental change in height of the insole with respect to the plantarsole.
 5. The orthopedic device according to claim 2, wherein theadjustment dial is configured for manual rotation including textures orshapes to aid with manual manipulation thereof, or includes an electricmotor and a control mechanism to allow for automatic adjustment of theadjustment dial.
 6. The orthopedic device according to claim 1, whereinthe footwear includes onboard electronics mechanisms to sense a level ofactivity of a user and to automatically adjust the height of the insolerelative to the plantar sole in response to the sensed activity level.7. The orthopedic device according to claim 1, wherein the footwearincludes onboard communication mechanisms configured to provide messagesto a practitioner for monitoring progress a wearer of the orthopedicdevice.
 8. The orthopedic device according to claim 1, the heightadjustment mechanism comprises: an adjustment screw passing through theplantar sole and connected to the insole by a universal joint totranslate rotation of the adjustment screw into vertical adjustment ofthe insole with respect to the plantar sole.
 9. The orthopedic deviceaccording to claim 1, wherein the height adjustment mechanism comprises:a bladder positioned between the insole and the plantar sole, thebladder having a valve connected thereto for automatically and/orselectively releasing gas or fluid therefrom.
 10. The orthopedic deviceaccording to claim 9, wherein the valve is a slow leak valve configuredto automatically and continuously release a predefined amount of gas orfluid from the bladder.
 11. The orthopedic device according to claim 9,further comprising: a processor, and wherein the valve is a solenoidvalve controlled by the processor to provide gradual and/or incrementalrelease of gas or fluid from the bladder.
 12. The orthopedic deviceaccording to claim 9, further comprising: removable and interchangeableheel wedges having different heights provided in combination with thebladder to adjust the height of the insole with respect to the plantarsole.
 13. The orthopedic device according to claim 9, furthercomprising: removable heel wedges having consistent heights provided incombination with the bladder to adjust the height of the insole withrespect to the plantar sole.
 14. The orthopedic device according toclaim 1, wherein the height adjustment mechanism comprises: a heel wedgehaving a plurality of integrally formed layers connected at an anteriorportion thereof; wherein a proximal surface of the heel wedge forms atleast a portion of the insole, and the layers of the heel wedge can beselectively removed from the heel wedge in order to adjust the height ofthe proximal surface of the heel wedge with respect to the plantar sole.15. The orthopedic device according to claim 14, wherein the heel wedgeincludes a heel stop provided on the proximal surface of the heel wedge.16. The orthopedic device according to claim 15, wherein the heel stophas a generally triangular shape with a raised ridge provided on aproximal surface thereof
 17. The orthopedic device according to claim15, wherein the heel stop has a generally trapezoidal shape defining aplanar surface at a raised ridge provided on a proximal surface thereof.18. The orthopedic device according to claim 15, wherein the heel stopis secured to the heel wedge with adhesive.
 19. The orthopedic deviceaccording to claim 15, wherein the layers of the heel wedge are formedfrom a material having a hardness in the range of 35-60 shore and theheel stop is formed from a compression molded EVA foam, or an injectedmolded TPE.
 20. The orthopedic device according to claim 1, wherein theheight adjustment mechanism comprises: a hydraulic or pneumatic cylinderprovided between the insole and plantar sole for adjusting the height ofthe insole with respect to the plantar sole.